title: Thrombolysis with alteplase 4.5-6 hours after acute ischemic stroke.
abstract: BACKGROUND
  The safety of intravenous (IV) thrombolysis when administered between 4.5 and 6 h after acute ischemic stroke with alteplase has not been established.
  
  
  OBJECTIVE
  The objective of this study was to investigate the safety of IV alteplase thrombolysis within a 6-hour time frame following ischemic stroke.
  
  
  METHODS
  Eligible patients were categorized as having treatment within 4.5 h or from 4.5 to 6 h and were evaluated for the following end points: disability at 90 days as measured by the modified Rankin Scale, incidence of mortality, and type 2 parenchymal hemorrhages.
  
  
  RESULTS
  100 patients were enrolled in our study (58 within 4.5 h after stroke and 42 between 4.5 and 6 h). After 90 days, 47.6% of the patients in the 4.5-6 h group reached independence in comparison to 44.8% patients in the 4.5 h group (p = 0.840). The incidence of type 2 parenchymal hemorrhage in the patients treated between 4.5-6 h and those treated within 4.5 h were 7.1 and 8.6%, respectively (p = 1.00). The incidence of mortality was 7.1 and 17.2% for the 4.5-6 and 4.5 h groups, respectively (p = 0.228).
  
  
  CONCLUSIONS
  IV thrombolysis in patients who fulfill the NINDS study criteria may still be considered up to 6 h after ischemic stroke.
authors.affiliation: Department of Neurology, The Sixth People's Hospital/Shanghai Jiaotong University, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: Xiao-jiang
authors.initials: XJ
authors.lastname: Sun
authors.forename: Chi-heng
authors.initials: CH
authors.lastname: Ju
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D016009:Chi-Square Distribution; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator